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Why A Physician Shortage Is Inevitable

Mon, 12/30/2013 - 5:49am
Kevin R. Campbell, M.D.

This week in the New York Times, Drs. Scott Gottlieb and Ezekiel Emanuel make the case that there will not be a physician shortage as a result of the Affordable Care Act (ACA). Both have extensive experience in policy and have held respected positions in government.

Based on a projected need of nearly 90,000 more physicians by 2020, I have difficulty seeing how a shortage will not occur. The Affordable Care Act has already demonstrated the ineptness of government to manage healthcare — the laughable website rollout, newly discovered “backend” issues with signups, inaccurate quotes and information and questionable security (and this is all since October). Now, as the mandates loom, consumers are beginning to wonder where exactly they will be able to get care and who may be providing it.

How can there not be a physician shortage?

Using the Massachusetts health care plan as an example, Drs. Gottlieb and Emmanuel argue that the shortage predictions are flawed. However, Massachusetts is not at all representative of the entirely of the US — one cannot extrapolate the response in Massachusetts to the rural midwest, or the deep south or sunny California.

Moreover, the provisions and funding of the legislation in Massachusetts are very different from those in the ACA. They argue that the biggest driver of increased physician manpower needs is more related to an aging population rather than the impacts of Obamacare and the flood of new patients that are insured by either Medicaid or the ACA exchanges that are able to set reimbursement levels at new all time lows. They state that the solution to shortage issues will come in the form of technology driven “remote medicine” and the use of non-physician extenders such as advanced practice nurses and physician assistants.

Moreover, they go on to argue that the solution is not producing more doctors — rather it is getting those of us in current practice to become “more efficient.”

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